System and method for pretreatement imaging in adaptive radiation therapy

ABSTRACT

A system and method for adapting treatment plan are provided. The method may include: obtaining a planning image of a region of interest relating to a first treatment fraction of a first treatment plan; obtaining a first image of the region of interest relating to a first scan of the region of interest with a first dose level; comparing the planning image with the first image to generate a first comparison result; determining whether the first comparison result satisfies a first replanning condition; causing, in response to a determination that the first comparison result satisfies the first replanning condition, one or more scanners to perform a second scan with a second dose level to provide a second image; and generating a second treatment plan according to the second image, wherein the second dose level is higher than the first dose level.

TECHNICAL FIELD

The present disclosure generally relates to systems and methods forradiation therapy, and more particularly, to systems and methods foradapting a radiation therapy treatment plan based on pretreatmentimaging.

BACKGROUND

Radiation therapy is widely used in cancer therapy and is also indicatedfor several other health conditions. Conventionally, a radiation therapytreatment plan (also referred herein as a treatment plan) for a cancerpatient is generated before treatment starts. The treatment plan may bedelivered to the patient during several treatment fractions, spread overa treatment period of multiple days. However, during the treatmentperiod, the anatomy of the tumor or other tissues (e.g., tissuesurrounding the tumor) may change. For example, the tumor may grow,deform, or shrink. Accordingly, the treatment plan may need to beupdated. Thus, it may be desirable to develop systems and methods foradapting a treatment plan during the course of the treatment period.

SUMMARY

In a first aspect of the present disclosure, a system for adaptingtreatment plan is provided. The system may include one or more scanners,at least one storage medium including a set of instructions for adaptingtreatment plan, and at least one processor configured to communicatewith the at least one storage medium. When executing the set ofinstructions, the system may be directed to perform followingoperations. A planning image of a region of interest relating to a firsttreatment plan may be obtained. A first image of the region of interestrelating to a first scan of the region of interest with a first doselevel may be obtained. The planning image may be compared with the firstimage to generate a first comparison result. The system may determinewhether the first comparison result satisfies a first replanningcondition. The system may cause, in response to a determination that thefirst comparison result satisfies the first replanning condition, theone or more scanners to perform a second scan with a second dose levelto provide a second image. A second treatment plan may be generatedaccording to the second image, wherein the second dose level may behigher than the first dose level.

In some embodiments, the system may send an instruction to a radiationtreatment device to deliver the second treatment plan to the region ofinterest.

In some embodiments, the first scan may be a cone beam computedtomography (CBCT) scan, and the second scan may be a multislice computedtomography (MSCT) scan.

In some embodiments, to compare the planning image with the first image,the system may be further directed to perform following operations. Atleast one first value with respect to at least one metric based on theplanning image may be determined. At least one second value with respectto the at least one metric based on the first image may be determined.The at least one first value may be compared with the at least onesecond value.

In some embodiments, to determine whether the first comparison resultsatisfies the first replanning condition, the system may be furtherdirected to determine whether a difference between the first value andthe second value exceeds a threshold.

In some embodiments, the at least one metric may be associated with ananatomical feature in the region of interest.

In some embodiments, the system ay be further directed to send, inresponse to a determination that the first comparison result fails tosatisfy the first replanning condition, an instruction to the radiationtreatment device to deliver the first treatment plan to the region ofinterest.

In some embodiments, to compare the planning image with the first image,the system may be further directed to perform following operations. Atleast one second comparison result of at least one second treatmentfraction performed prior to the first treatment fraction may beobtained. Based on the first comparison result and the at least onesecond comparison result, whether a second replanning condition issatisfied may be determined. In response to the determination that thesecond replanning condition is satisfied, a third image relating to athird scan of the region of interest may be obtained. A third treatmentplan may be determined based on the third image. In some embodiments,the third scan is an MSCT scan with a third dose level greater than thefirst dose level.

In some embodiments, the treatment plan includes a plurality oftreatment fractions, and the system may be further directed to performfollowing operations. Whether the first comparison result satisfies athird replanning condition may be determined. In response to thedetermination that the first comparison result satisfies the thirdreplanning condition, a fourth image relating to a fourth scan of theregion of interest may be obtained. A fourth treatment plan may bedetermined based on the fourth image. In some embodiments, the fourthscan may be an MSCT scan with a fourth dose level greater than the firstdose level.

In some embodiments, the first and second scan may be multislicecomputed tomography (MSCT) scans.

In some embodiments, the first image or the second image may be an MSCTimage obtained by a MSCT scanner, and MSCT imaging bore of the MSCTscanner may share a common axis of rotation with a bore of a radiationtreatment device.

In a second aspect of the present disclosure, a method for adaptingtreatment plan is provided. The method may include following operations.A planning image of a region of interest relating to a first treatmentplan may be obtained. A first image of the region of interest relatingto a first scan of the region of interest with a first dose level may beobtained. The planning image may be compared with the first image togenerate a first comparison result. Whether the first comparison resultsatisfies a first replanning condition may be determined. The method mayinclude causing, in response to a determination that the firstcomparison result satisfies the first replanning condition, the one ormore scanners to perform a second scan with a second dose level toprovide a second image. A second treatment plan may be generatedaccording to the second image, wherein the second dose level may behigher than the first dose level.

In some embodiments, an instruction may be sent to a radiation treatmentdevice to deliver the second treatment plan to the region of interest.

In some embodiments, the first scan may be a cone beam computedtomography (CBCT) scan, and the second scan may be a multislice computedtomography (MSCT) scan.

In some embodiments, to compare the planning image with the first image,the method may further include following operations. At least one firstvalue with respect to at least one metric based on the planning imagemay be determined. At least one second value with respect to the atleast one metric based on the first image may be determined. The atleast one first value may be compared with the at least one secondvalue.

In some embodiments, to determine whether the first comparison resultsatisfies the first replanning condition, the method may furtherincluding determine whether a difference between the first value and thesecond value exceeds a threshold.

In some embodiments, the at least one metric may be associated with ananatomical feature in the region of interest.

In some embodiments, the method may further including sending, inresponse to a determination that the first comparison result fails tosatisfy the first replanning condition, an instruction to the radiationtreatment device to deliver the first treatment plan to the region ofinterest.

In some embodiments, to compare the planning image with the first image,the method may further include following operations. At least one secondcomparison result of at least one second treatment fraction performedprior to the first treatment fraction may be obtained. Based on thefirst comparison result and the at least one second comparison result,whether a second replanning condition is satisfied may be determined. Inresponse to the determination that the second replanning condition issatisfied, a third image relating to a third scan of the region ofinterest may be obtained. A third treatment plan may be determined basedon the third image. In some embodiments, the third scan is an MSCT scanwith a third dose level greater than the first dose level.

In some embodiments, the treatment plan includes a plurality oftreatment fractions, and the method may further include followingoperations. Whether the first comparison result satisfies a thirdreplanning condition may be determined. In response to the determinationthat the first comparison result satisfies the third replanningcondition, a fourth image relating to a fourth scan of the region ofinterest may be obtained. A fourth treatment plan may be determinedbased on the fourth image. In some embodiments, the fourth scan may bean MSCT scan with a fourth dose level greater than the first dose level.

In some embodiments, the first and second scan may be multislicecomputed tomography (MSCT) scans.

In some embodiments, the first image or the second image may be an MSCTimage obtained by a MSCT scanner, and MSCT imaging bore of the MSCTscanner may share a common axis of rotation with a bore of a radiationtreatment device.

In a third aspect of the present disclosure, a non-transitory computerreadable medium is provided. The non-transitory computer readable mediummay include executable instructions. When at least one processorexecutes the instructions, the at least one processor may effectuate amethod including one or more of the following operations. A planningimage of a region of interest relating to a first treatment plan may beobtained. A first image of the region of interest relating to a firstscan of the region of interest with a first dose level may be obtained.The planning image may be compared with the first image to generate afirst comparison result. Whether the first comparison result satisfies afirst replanning condition may be determined. The method may includecausing, in response to a determination that the first comparison resultsatisfies the first replanning condition, the one or more scanners toperform a second scan with a second dose level to provide a secondimage. A second treatment plan may be generated according to the secondimage, wherein the second dose level may be higher than the first doselevel.

BRIEF DESCRIPTION OF THE DRAWINGS

The present disclosure is further described in terms of exemplaryembodiments. These exemplary embodiments are described in detail withreference to the drawings. The drawings are not to scale. Theseembodiments are non-limiting exemplary embodiments, in which likereference numerals represent similar structures throughout the severalviews of the drawings, and wherein:

FIG. 1 is a schematic diagram illustrating an exemplary radiationtherapy system according to some embodiments of the present disclosure;

FIG. 2 is a schematic diagram illustrating hardware and/or softwarecomponents of an exemplary computing device according to someembodiments of the present disclosure;

FIG. 3 is a schematic diagram illustrating hardware and/or softwarecomponents of an exemplary mobile device according to some embodimentsof the present disclosure;

FIG. 4 is a block diagram illustrating an exemplary processing engineaccording to some embodiments of the present disclosure;

FIGS. 5-A and 5-B are flowcharts illustrating an exemplary process foradapting a radiation therapy treatment plan according to someembodiments of the present disclosure.

DETAILED DESCRIPTION

In the following detailed description, numerous specific details are setforth by way of examples in order to provide a thorough understanding ofthe relevant disclosure. However, it should be apparent to those skilledin the art that the present disclosure may be practiced without suchdetails. In other instances, well known methods, procedures, systems,components, and/or circuitry have been described at a relativelyhigh-level, without detail, in order to avoid unnecessarily obscuringaspects of the present disclosure. Various modifications to thedisclosed embodiments will be readily apparent to those skilled in theart, and the general principles defined herein may be applied to otherembodiments and applications without departing from the spirit and scopeof the present disclosure. Thus, the present disclosure is not limitedto the embodiments shown, but to be accorded the widest scope consistentwith the claims.

It will be understood that the term “system,” “engine,” “unit,”“module,” and/or “block” used herein are one method to distinguishdifferent components, elements, parts, section or assembly of differentlevel in ascending order. However, the terms may be displaced by otherexpression if they may achieve the same purpose.

Generally, the word “module,” “unit,” or “block,” as used herein, refersto logic embodied in hardware or firmware, or to a collection ofsoftware instructions. A module, a unit, or a block described herein maybe implemented as software and/or hardware and may be stored in any typeof non-transitory computer-readable medium or other storage device. Insome embodiments, a software module/unit/block may be compiled andlinked into an executable program. It will be appreciated that softwaremodules can be callable from other modules/units/blocks or fromthemselves, and/or may be invoked in response to detected events orinterrupts. Software modules/units/blocks configured for execution oncomputing devices (e.g., processor 210 as illustrated in FIG. 2) may beprovided on a computer readable medium, such as a compact disc, adigital video disc, a flash drive, a magnetic disc, or any othertangible medium, or as a digital download (and can be originally storedin a compressed or installable format that needs installation,decompression, or decryption prior to execution). Such software code maybe stored, partially or fully, on a storage device of the executingcomputing device, for execution by the computing device. Softwareinstructions may be embedded in a firmware, such as an erasableprogrammable read-only memory (EPROM). It will be further appreciatedthat hardware modules/units/blocks may be included of connected logiccomponents, such as gates and flip-flops, and/or can be included ofprogrammable units, such as programmable gate arrays or processors. Themodules/units/blocks or computing device functionality described hereinmay be implemented as software modules/units/blocks, but may berepresented in hardware or firmware. In general, themodules/units/blocks described herein refer to logicalmodules/units/blocks that may be combined with othermodules/units/blocks or divided into sub-modules/sub-units/sub-blocksdespite their physical organization or storage.

It will be understood that when a unit, engine, module or block isreferred to as being “on,” “connected to,” or “coupled to” another unit,engine, module, or block, it may be directly on, connected or coupledto, or communicate with the other unit, engine, module, or block, or anintervening unit, engine, module, or block may be present, unless thecontext clearly indicates otherwise. As used herein, the term “and/or”includes any and all combinations of one or more of the associatedlisted items.

The terminology used herein is for the purposes of describing particularexamples and embodiments only, and is not intended to be limiting. Asused herein, the singular forms “a,” “an,” and “the” may be intended toinclude the plural forms as well, unless the context clearly indicatesotherwise. It will be further understood that the terms “include” and/or“comprise,” when used in this disclosure, specify the presence ofintegers, devices, behaviors, stated features, steps, elements,operations, and/or components, but do not exclude the presence oraddition of one or more other integers, devices, behaviors, features,steps, elements, operations, components, and/or groups thereof.

Provided herein are systems and components for non-invasive imagingand/or treatment, such as for disease diagnosis, treatment or researchpurposes. In some embodiments, the system ay be a radiation therapysystem, a computed tomography (CT) system, an emission computedtomography (ECT) system, an X-ray photography system, a positronemission tomography (PET) system, or the like, or any combinationthereof. For illustration purposes, the disclosure describes systems andmethods for radiation therapy. The term “image” used in this disclosuremay refer to a 2D image, a 3D image, or a 4D image. In some embodiments,the term “image” may refer to image of a region of interest (ROI) of apatient. The term “region of interest” or “ROI” used in this disclosuremay refer to a part of an image along a line, in two spatial dimensions,in three spatial dimensions, or any of the proceeding as they evolve asa function of time. The image may be a CT image, an EPID (ElectronicPortal Image Device) image, a fluoroscopy image, an ultrasound image, aPET image or an MRI image. The term “planning image” used in thisdisclosure may refer to an image according to which a treatment plan ismade. The term “treatment plan” in this disclosure may include a set ofparameters describing how the radiation is delivered to the patient,including but not limited to beam aperture size, radiation dose leveldistribution, radiation duration, and position of radiation target ofthe patient. The planning image may be used to identify radiotherapytargets, organs at risk, and patient external contour (e.g., skin).Tissue attenuation values yielded by the planning image may be convertedto electron densities and are used to perform radiation dose levelcalculation. The treatment plan may include one or more treatmentfractions. For each of the treatment fraction, the radiation treatmentplan may include a plurality of treatment parameters, such as a plannedfraction duration, a planned radiation dose level, a planned radiationenergy delivery direction, a planned radiation energy beam shape, aplanned radiation beam cross-sectional area, a planned region ofinterest (ROI), etc.

The term “guiding image” used in this disclosure may include an imagetaken during or before the radiation therapy to guide radiationdelivery. The guiding image may include a low dose level guiding imagefor determining radiotherapy target position, and a high dose levelguiding image for adapting the treatment plan during or before theradiotherapy.

The term “image data” used in this disclosure may refer to radiationdata (e.g., CT data) and projection data corresponding to the radiationdata. This is not intended to limit the scope the present disclosure.For persons having ordinary skills in the art, a certain number ofvariations, changes, and/or modifications may be deduced under theguidance of the present disclosure. Those variations, changes, and/ormodifications do not depart from the scope of the present disclosure.

Before a patient receives radiation therapy (e.g., days before or weeksbefore), the planning image may be taken, and a treatment plan may bedesigned for the patient based on the planning image. A guide image maybe taken to guide radiation delivery during or before the radiationtherapy (e.g., on the day of treatment, or hours before the treatment,or minutes before the treatment, or seconds before the treatment, orduring the treatment). However, radiotherapy targets, organs at risk,and patient external contour may change during or before the radiationtherapy, and thus, the treatment plan may need to be modified in realtime to accommodate the changes. As adapting of the treatment planduring or before the radiation therapy is uncertain, the patient may beat risk of exposure to unnecessary radiation. For example, if thetreatment plan does not need to be modified in real time, a patient maysuffer unnecessary radiation dose level if a high dose level guidingimage is taken during the radiation therapy. As another example, if thetreatment plan needs to be modified in real time, a low dose levelguiding image may be not precise enough to modify the treatment plan,therefore causing the deviation of the radiation delivery. Thus, anaspect of the present disclosure relates to systems and methods foradapting guiding image dose level based on images acquired before orduring a treatment.

In this disclosure, before the treatment plan is prescribed, a planningimage of the treatment plan regarding a subject may be obtained. Duringor before the radiation therapy (e.g., on the day of treatment, or hoursbefore the treatment, or minutes before the treatment, or seconds beforethe treatment), a CT scan of a first dose level may be performed togenerate a first image (e.g., a low dose level guiding image). Adecision may be made as to whether a high dose level guiding image isneeded during or before the treatment based on the planning image andthe first image by comparing anatomical information of the two images.Demand for a high dose level guiding image may be triggered when thecomparison of anatomical information indicates a significant change ofanatomical information indicated by, for example, a difference betweenthe anatomical information being greater than a threshold. In responseto the determination that the high dose level guiding image is needed, aCT scan of a second dose level may be performed to generate a secondimage (e.g., a high dose level guiding image). A second treatment planmay be generated based on the second image. The first dose level may belower than the second dose level. As such, the treatment plan may beadapted timely and accurately if the treatment plan needs to bemodified, and a patient may not suffer unnecessary radiation dose levelif the treatment plan does not need to be modified. In functionalimaging modalities (e.g., positron emission tomography (PET), orcontrast-enhanced CT, etc.), the same argument applies to changes ofphysiological parameters. For example, a planning PET image is takenwith a physiological parameter, e.g., a first tracer concentrationlevel, before the radiation therapy. If a first PET image, obtainedduring or before the radiation therapy, indicates that thisphysiological parameter has changed beyond a threshold, then a secondPET image, of which tracer concentration level is higher than that ofthe planning PET image may be taken for replanning, using the same oranother tracer compound.

FIG. 1 is a schematic diagram illustrating an exemplary radiationtherapy system 100 according to some embodiments of the presentdisclosure. The radiation therapy system 100 may include an image-guidedtreatment apparatus 110, a network 120, one or more terminals 130, aprocessing device 140, and a storage device 150.

The image-guided treatment apparatus 110 may include an imagingcomponent, a treatment component, a gantry 111, a table 114, an imagedregion 113, or the like. The imaging component may include animaging-radiation source 115, a detector 112, or the like. The treatmentcomponent may include a treatment radiation source 116, an accelerator(not shown in FIG. 1), or the like. The gantry 111 may be configured toaccommodate the imaging component and the treatment component, such asthe imaging-radiation source 115, the detector 112, and the treatmentradiation source 116. A subject may be placed on the table 114 fortreatment and/or scan.

The imaging component may generate an image of the subject before,during and/or after a treatment fraction. The imaging component mayinclude a computed tomography (CT) component, an ultrasound imagingcomponent, a fluoroscopy imaging component, a magnetic resonance imaging(MRI) component, a single photon emission computed tomography (SPECT)component, a positron emission tomography (PET) component, or the like,or any combination thereof.

The imaging-radiation source 115 may emit radiation toward the subject.The detector 112 may detect radiation events (e.g., x-ray photons,gamma-ray photons) emitted from the imaged region 113. In someembodiments, the detector 112 may include one or more detector units.The detector units may include a scintillation detector (e.g., a cesiumiodide detector, a gadolinium oxysulfide detector), a gas detector, etc.The detector unit may include a single-row detector and/or a multi-rowsdetector.

In some embodiments, the imaging component may be a CBCT imagingcomponent. The CBCT imaging component may perform a CBCT scan on thesubject by emitting cone beam X-rays to the subject. In someembodiments, the imaging component may be a multi-slice CT (MSCT)imaging component. The MSCT imaging component may perform an MSCT scanof the subject. In some embodiments, the imaging component may be anintegrated. CT imaging component that can perform a CBCT scan and anMSCT scan. An MSCT scan is comprised of one or more axial slices of theimaged object (usually the patient, or human or animal subject).

The treatment component may deliver radiation treatment to the subject.The treatment radiation source 116 may emit treatment radiations towardsthe subject. The therapy radiations may be accelerated by, for example,an accelerator (not shown in FIG. 1) and irradiate on the subject.

In some embodiments, the image-guided treatment apparatus 110 mayinclude two gantries that house the imaging component and the treatmentcomponent, respectively. The imaging component (e.g., theimaging-radiation source 115 and the detector 112) and the correspondinggantry may be spaced by a distance from the treatment component (e.g.,the treatment radiation source 116) and the corresponding gantry. Insome embodiments, the corresponding gantry of the imaging component andthe corresponding gantry of the imaging component may have collinearbore. For example, bore of the imaging component gantry and bore of thetreatment component gantry may share an axis of rotation. The subjectmay be positioned in different positions in the table 114 for imagingand treatment. In some embodiments, the imaging-radiation source 115 andthe treatment radiation source 116 may be integrated as one radiationsource to image and/or treat the subject.

In some embodiments, the radiation therapy system 100 may include aradiation treatment device, and a CT scanner. Such device is describedin US publication No. 20170189720A1 entitled as “radiation therapysystem”, US publication No. 20170189719A1 entitled as “radiation therapypositioning system”, and US publication No. 20170189724A1 entitled as“radiation therapy system”, and the contents of these applications arereferenced herein and incorporated into this application. The radiationtreatment device may include one or more components that is the same asor substantially similar to those of the image-guided treatmentapparatus 110. For example, the radiation treatment device may includethe same components as the image-guided treatment apparatus 110. Asanother example, the radiation treatment device may include a treatmentcomponent, a gantry, a table, and a detecting region.

In some embodiments, the CT scanner may be a CBCT scanner and/or an MSCTscanner. The CBCT scanner may perform a CBCT scan of a subject. The MSCTscanner may perform an MSCT scan of a subject. The images generatedbased on the CBCT scan or the MSCT scan may be stored in a storagedevice in the radiation therapy system 100 for adaptive radiationtherapy planning. The CBCT scanner or the MSCT scanner may include oneor more components of a CT scanner known to a person of ordinary skillin the art. For example, the CBCT scanner may include a gantry, adetector, a detecting region, a table, and a CBCT radiation-emittingscanning source.

Merely by way of example, the radiation therapy system 100 may includean MSCT scanner and a radiation treatment device including a CBCTimaging component and a treatment component. The MSCT scanner mayperform an MSCT scan of a subject. The radiation treatment deviceincluding the CBCT imaging component and the treatment component mayperform a CBCT scan and/or treat the subject. Additionally oralternatively, the radiation therapy system 100 may include a CBCTscanner and a radiation treatment device including an MSCT imagingcomponent and a treatment component. Bore of the MSCT imaging componentmay share an axis of rotation with the treatment component.

The network 120 may include any suitable network that can facilitate theexchange of information and/or data for the radiation therapy system100. In some embodiments, one or more components of the radiationtherapy system 100 (e.g., the image-guided treatment apparatus 110, theterminal 130, the processing device 140, the storage device 150, etc.)may communicate information and/or data with one or more othercomponents of the radiation therapy system 100 via the network 120. Forexample, the processing device 140 may obtain image data from theimage-guided treatment apparatus 110 via the network 120. As anotherexample, the processing device 140 may obtain user instructions from theterminal 130 via the network 120. The network 120 may be and/or includea public network (e.g., the Internet), a private network (e.g., a localarea network (LAN), a wide area network (WAN))), a wired network (e.g.,an Ethernet network), a wireless network (e.g., an 802.11 network, aWi-Fi network), a cellular network (e.g., a Long Term Evolution (LTE)network), a frame relay network, a virtual private network (“VPN”), asatellite network, a telephone network, routers, hubs, switches, servercomputers, and/or any combination thereof. Merely by way of example, thenetwork 120 may include a cable network, a wireline network, afiber-optic network, a telecommunications network, an intranet, awireless local area network (WLAN), a metropolitan area network (MAN), apublic telephone switched network (PSTN), a Bluetooth™ network, aZigBee™ network, a near field communication (NEC) network, or the like,or any combination thereof. In some embodiments, the network 120 mayinclude one or more network access points. For example, the network 120may include wired and/or wireless network access points such as basestations and/or internet exchange points through which one or morecomponents of the radiation therapy system 100 may be connected to thenetwork 120 to exchange data and/or information.

The terminal(s) 130 may include a mobile device 130-1, a tablet computer130-2, a laptop computer 130-3, or the like, or any combination thereof.In some embodiments, the mobile device 130-1 may include a smart homedevice, a wearable device, a mobile device, a virtual reality device, anaugmented reality device, or the like, or any combination thereof.Merely by way of example, the terminal 130 may include a mobile deviceas illustrated in FIG. 3. In some embodiments, the smart home device mayinclude a smart lighting device, a control device of an intelligentelectrical apparatus, a smart monitoring device, a smart television, asmart video camera, an interphone, or the like, or any combinationthereof. In some embodiments, the wearable device may include abracelet, footwear, eyeglasses, a helmet, a watch, clothing, a backpack,a smart accessory, or the like, or any combination thereof. In someembodiments, the mobile device may include a mobile phone, a personaldigital assistance (PDA), a gaming device, a navigation device, a pointof sale (POS) device, a laptop, a tablet computer, a desktop, or thelike, or any combination thereof. In some embodiments, the virtualreality device and/or the augmented reality device may include a virtualreality helmet, virtual reality glasses, a virtual reality patch, anaugmented reality helmet, augmented reality glasses, an augmentedreality patch, or the like, or any combination thereof. For example, thevirtual reality device and/or the augmented reality device may include aGoogle Glass™, an Oculus Rift™, a Hololens™, a Gear VR™, etc. In someembodiments, the terminal(s) 130 may be part of the processing device140.

The processing device 140 may process data and/or information obtainedfrom the image-guided treatment apparatus 110, the terminal 130, and/orthe storage device 150. In some embodiments, the processing device 140may be a single server or a server group. The server group may becentralized or distributed. In some embodiments, the processing device140 may be local or remote. For example, the processing device 140 mayaccess information and/or data stored in the image-guided treatmentapparatus 110, the terminal 130, and/or the storage device 150 via thenetwork 120. As another example, the processing device 140 may bedirectly connected to the image-guided treatment apparatus 110, theterminal 130 and/or the storage device 150 to access stored informationand/or data. In some embodiments, the processing device 140 may beimplemented on a cloud platform. Merely by way of example, the cloudplatform may include a private cloud, a public cloud, a hybrid cloud, acommunity cloud, a distributed cloud, an inter-cloud, a multi-cloud, orthe like, or any combination thereof. In some embodiments, theprocessing device 140 may be implemented by a computing device 200having one or more components as illustrated in FIG. 2.

The storage device 150 may store data, instructions, and/or any otherinformation. In some embodiments, the storage device 150 may store dataobtained from the terminal 130 and/or the processing device 140. In someembodiments, the storage device 150 may store data and/or instructionsthat the processing device 140 may execute or use to perform exemplarymethods described in the present disclosure. In some embodiments, thestorage device 150 may include a mass storage, removable storage, avolatile read-and-write memory, a read-only memory (ROM), or the like,or any combination thereof. Exemplary mass storage include a magneticdisk, an optical disk, a solid-state drive, etc. Exemplary removablestorage may include a flash drive, a floppy disk, an optical disk, amemory card, a zip disk, a magnetic tape, etc. Exemplary volatileread-and-write memory may include a random access memory (RAM).Exemplary RAM may include a dynamic RAM (DRAM), a double date ratesynchronous dynamic RAM (DDR SDRAM), a static RAM (SRAM), a thyristorRAM (T-RAM), and a zero-capacitor RAM (Z-RAM), etc. Exemplary ROM mayinclude a mask ROM (MROM), a programmable ROM (PROM), an erasableprogrammable ROM (EPROM), an electrically erasable programmable ROM(EEPROM), a compact disk ROM (CD-ROM), and a digital versatile disk ROM,etc. In some embodiments, the storage device 150 may be implemented on acloud platform. Merely by way of example, the cloud platform may includea private cloud, a public cloud, a hybrid cloud, a community cloud, adistributed cloud, an inter-cloud, a multi-cloud, or the like, or anycombination thereof.

In some embodiments, the storage device 150 may be connected to thenetwork 120 to communicate with one or more other components of theradiation therapy system 100 (e.g., the processing device 140, theterminal 130). One or more components of the radiation therapy system100 may access the data or instructions stored in the storage device 150via the network 120. In some embodiments, the storage device 150 may bedirectly connected to or communicate with one or more other componentsof the radiation therapy system 100 (e.g., the processing device 140,the terminal 130). In some embodiments, the storage device 150 may bepart of the processing device 140.

FIG. 2 is a schematic diagram illustrating exemplary hardware and/orsoftware components of an exemplary computing device 200 on which theprocessing device 140 may be implemented according to some embodimentsof the present disclosure. As illustrated in FIG. 2, the computingdevice 200 may include a processor 210, storage 220, an input/output(I/O) 230, and a communication port 240.

The processor 210 may execute computer instructions (e.g., program code)and perform functions of the processing device 140 in accordance withtechniques described herein. The computer instructions may include, forexample, routines, programs, objects, components, data structures,procedures, modules, and functions, which perform particular functionsdescribed herein. For example, the processor 210 may process image dataobtained from the image-guided treatment apparatus 110, the terminal130, the storage device 150, and/or any other component of the radiationtherapy system 100. In some embodiments, the processor 210 may includeone or more hardware processors, such as a microcontroller, amicroprocessor, a reduced instruction set computer (RISC), anapplication specific integrated circuits (ASICs), anapplication-specific instruction-set processor (ASIP), a centralprocessing unit (CPU), a graphics processing unit (GPU), a physicsprocessing unit (PPU), a microcontroller unit, a digital signalprocessor (DSP), a field programmable gate array (FPGA), an advancedRISC machine (ARM), a programmable logic device (PLD), any circuit orprocessor capable of executing one or more functions, or the like, orany combinations thereof.

Merely for illustration, only one processor is illustrated in thecomputing device 200 in FIG. 2. However, it should be noted that thecomputing device 200 in the present disclosure may also include multipleprocessors, and thus operations and/or method steps that are performedby one processor as described in the present disclosure may also bejointly or separately performed by the multiple processors. For example,if in the present disclosure the processor of the computing device 200executes both operations A and operation B, it should be understood thatoperation A and operation B may also be performed by two or moredifferent processors jointly or separately in the computing device 200(e.g., a first processor executes operation A and a second processorexecutes operation B, or the first and second processors jointly executeoperations A and B).

The storage 220 may store data/information obtained from theimage-guided treatment apparatus 110, the terminal 130, the storagedevice 150, and/or any other component of the radiation therapy system100. In some embodiments, the storage 220 may include a mass storage,removable storage, a volatile read-and-write memory, a read-only memory(ROM), or the like, or any combination thereof. For example, the massstorage may include a magnetic disk, an optical disk, a solid-statedrives, etc. The removable storage may include a flash drive, a floppydisk, an optical disk, a memory card, a zip disk, a magnetic tape, etc.The volatile read-and-write memory may include a random access memory(RAM). The RAM may include a dynamic RAM (DRAM), a double date ratesynchronous dynamic RAM (DDR SDRAM), a static RAM (SRAM), a thyristorRAM (T-RAM), and a zero-capacitor RAM (Z-RAM), etc. The ROM may includea mask ROM (MROM), a programmable ROM (PROM), an erasable programmableROM (EPROM), an electrically erasable programmable ROM (EEPROM), acompact disk ROM (CD-ROM), and a digital versatile disk ROM, etc. Insome embodiments, the storage 220 may store one or more programs and/orinstructions to perform exemplary methods described in the presentdisclosure.

The I/O 230 may input and/or output signals, data, information, etc. Insome embodiments, the I/O 230 may enable a user interaction with theprocessing device 140. In some embodiments, the I/O 230 may include aninput device and an output device. Examples of the input device mayinclude a keyboard, a mouse, a touch screen, a microphone, or the like,or a combination thereof. Examples of the output device may include adisplay device, a loudspeaker, a printer, a projector, or the like, or acombination thereof. Examples of the display device may include a liquidcrystal display (LCD), a light-emitting diode (LED)-based display, aflat panel display, a curved screen, a television device, a cathode raytube (CRT), a touch screen, or the like, or a combination thereof.

The communication port 240 may be connected to a network (e.g., thenetwork 120) to facilitate data communications. The communication port240 may establish connections between the processing device 140 and theimage-guided treatment apparatus 110, the terminal 130, and/or thestorage device 150. The connection may be a wired connection, a wirelessconnection, any other communication connection that can enable datatransmission and/or reception, and/or any combination of theseconnections. The wired connection may include, for example, anelectrical cable, an optical cable, a telephone wire, or the like, orany combination thereof. The wireless connection may include, forexample, a Bluetooth™ link, a Wi-Fi™ link, a WiMax™ link, a WLAN link, aZigBee link, a mobile network link (e.g., 3G, 4G, 5G etc.), or the like,or a combination thereof. In some embodiments, the communication port240 may be and/or include a standardized communication port, such asRS232, RS485, etc. In some embodiments, the communication port 240 maybe a specially designed communication port. For example, thecommunication port 240 may be designed in accordance with the digitalimaging and communications in medicine (DICOM) protocol.

FIG. 3 is a schematic diagram illustrating exemplary hardware and/orsoftware components of an exemplary mobile device 300 on which theterminal 130 may be implemented according to some embodiments of thepresent disclosure. As illustrated in FIG. 3, the mobile device 300 mayinclude a communication platform 310, a display 320, a graphicprocessing unit (GPU) 330, a central processing unit (CPU) 340, an I/O350, a memory 360, and a storage 390. In some embodiments, any othersuitable component, including but not limited to a system bus or acontroller (not shown), may also be included in the mobile device 300.In some embodiments, a mobile operating system 370 (e.g., iOS™,Android™, Windows Phone™) and one or more applications 380 may be loadedinto the memory 360 from the storage 390 in order to be executed by theCPU 340. The applications 380 may include a browser or any othersuitable mobile apps for receiving and rendering information relating toimage processing or other information from the processing device 140.User interactions with the information stream may be achieved via theI/O 350 and provided to the processing device 140 and/or othercomponents of the radiation therapy system 100 via the network 120.

To implement various modules, units, and their functionalities describedin the present disclosure, computer hardware platforms may be used asthe hardware platform(s) for one or more of the elements describedherein. A computer with user interface elements may be used to implementa personal computer (PC) or any other type of work station or terminaldevice. A computer may also act as a server if appropriately programmed.

FIG. 4 is a block diagram illustrating an exemplary processing device140 according to some embodiments of the present disclosure. Theprocessing device 140 may include an acquisition unit 410, aregistration unit 420, a treatment plan unit 430, and a comparison unit440. The processing device 140 may be implemented on various components(e.g., the processor 210 of the computing device 200 as illustrated inFIG. 2).

The acquisition unit 410 may obtain one or more images related to an ROIof a patient. The one or more images may include a planning image and/ora guiding image. For example, the acquisition unit 410 may obtain aplanning image of a region of interest (ROI) relating to a treatmentfraction of a treatment plan. As another example, the acquisition unit410 may obtain a guiding image of the ROI produced by a scan, such as aCBCT scan and/or an MSCT scan. The acquisition unit 410 may obtain theone or more images from a storage device in the radiation therapy system100, such as the storage device 150.

The registration unit 420 may correct setup error between a guidingimage and a planning image. The setup error may describe discrepancybetween an intended treatment position where the planning image is takenand an actual treatment position where the guiding image is taken. Forexample, the registration unit 420 may register a guiding image producedby a CBCT scan with a planning image relating to a treatment plan. Theregistration unit 420 may perform the image registration based on anysuitable image registration techniques including, for example, avoxel-based registration technique, a landmark-based registrationtechnique, a segmentation-based registration technique, or the like, ora combination thereof. In some embodiments, registration unit 420 mayperform a rigid image registration.

The treatment plan unit 430 may obtain and/or generate a treatment plan.In some embodiments, the treatment plan unit 430 may generate atreatment plan based on an image, such as a planning image taken beforetreatment, a guiding image (e.g., a high dose level guiding image). Thetreatment plan generated by the treatment plan unit 430 may include oneor more treatment fractions. For each of the treatment fraction, thetreatment plan may include a plurality of treatment parameters, such asa planned fraction duration, a planned radiation dose level, a plannedradiation energy delivery direction, a planned radiation energy beamshape, a planned radiation beam cross-sectional area, a planned regionof interest (ROI), etc. Additionally or alternatively, the treatmentplan unit 430 may send an instruction to a radiation treatment device todeliver a treatment based on the treatment plan.

The comparison unit 440 may determine and/or obtain a compare result oftwo or more images. In some embodiments, the comparison unit 440 maycompare anatomy information of two images to generate a comparisonresult of the two images. For example, the comparison unit 440 maydetermine a first value of a metric based on a first image and a secondvalue of the metric based on a second image. The comparison unit 440 maythen compare the first value with the second value by way of, e.g.,determining a difference between the first value and the second value.The metric may include any suitable metric relating to a parameter orcharacteristic of an anatomical feature in the first image and/or thesecond image. The anatomical feature may include a malignant tissue(e.g., a tumor, or a cancer-ridden organ) or other tissue (e.g., atissue surrounding the malignant tissue). The metric may include thelocation of the anatomical feature, the shape of the anatomical feature,the density of the anatomical feature, the volume of the anatomicalfeature, an attenuation value of the anatomical feature, or the like, orany combination thereof. The difference between the first value and thesecond value of the metric may be designated as the comparison result ofthe two images by the comparison unit 440.

In some embodiments, the registration unit 420 may register an imageproduced by a CBCT scan to a planning image relating to a firsttreatment fraction of a treatment plan. The comparison unit 440 maycompare a planning image with a registered image to generate a firstcomparison result. Additionally or alternatively, the comparison unit440 may make a determination as to whether the first comparison resultsatisfies a first replanning condition to identify a need forreplanning. In some embodiments, the comparison unit 440 may make adetermination as to whether the first comparison result and a secondcomparison result corresponding to a second treatment fraction performedprior to the first treatment fraction satisfy a second replanningcondition to identify a need for replanning.

It should be noted that the above descriptions of the processing device140 are provided for the purposes of illustration, and not intended tolimit the scope of the present disclosure. For persons having ordinaryskills in the art, various modifications and changes in the forms anddetails of the application of the above method and system may occurwithout departing from the principles of the present disclosure. In someembodiments, the processing device 140 may include one or more othermodules. In some embodiments, two or more units in the processing device140 may form one module. However, those variations and modificationsalso fall within the scope of the present disclosure.

FIGS. 5-A and 5-B illustrate a flowchart illustrating an exemplaryprocess for adapting guiding image dose level according to someembodiments of the present disclosure. In some embodiments, at leastpart of process 500 may be performed by the processing device 140(implemented in, for example, the computing device 200 shown in FIG. 2).

The radiation therapy may be a photon-based radiation therapy, a brachytherapy, an electron beam therapy, a proton therapy, a neutron therapy,a particle therapy, or other types of therapies. In some embodiments,the treatment plan may include a plurality of treatment fractions. Atleast part of the process 500 may be performed before one or moretreatment fractions of the plurality of the treatment fractions. In someembodiments, the treatment plan may include a single treatment fraction.At least part of the process 500 may be performed before the singletreatment fraction. Merely by way of example, operations illustrated inFIG. 5A may be performed before the single treatment fraction.

In 502, a planning image of a region of interest (ROI) relating to afirst treatment fraction of a first treatment plan may be obtained. Insome embodiments, 502 may be performed by the acquisition unit 410. Insome embodiments, the planning image may be obtained from a storagedevice in the radiation therapy system 100, such as the storage device150.

The first treatment plan may include a plurality of treatment fractions.The first treatment fraction may be any treatment fraction of theplurality of the treatment fractions. As used herein, a first treatmentfraction is used to refer to a treatment fraction to be performed withrespect to which an assessment is made as to whether the treatment planneeds to be revised. A treatment fraction performed prior to a firsttreatment fraction may be referred to as a prior treatment fraction or asecond treatment fraction. For instance, between a first treatmentfraction and a second treatment fraction, the first treatment fractionis performed subsequent to the second treatment fraction. The ROI may bea region of a patient including at least part of a malignant tissue(e.g., a tumor, a cancer-ridden organ, or non-cancerous target ofradiation therapy). Additionally or alternatively, the ROI may includeother tissue, such as a tissue surrounding the malignant tissue. In someembodiments, the planning image of the ROI acquired before the firsttreatment fraction is performed by an imaging acquisition device (e.g.,the image-guided treatment apparatus 110 including an imaging component,a CT scanner). The first treatment plan may be generated based on theplanning image and stored in the storage device (the storage device150).

Additionally or alternatively, the first treatment plan may include aplurality of first treatment parameters for each treatment fraction. Thefirst treatment parameters of a treatment fraction may include a firstplanned fraction duration, a first planned radiation dose level, a firstplanned radiation energy delivery direction, a first planned radiationenergy beam shape, a first planned radiation beam cross-sectional area,or the like, or any combination thereof.

In 504, the acquisition unit 410 may obtain a first image of the ROIproduced by a first scan of the ROI. The first scan may be performedwith a first dose level. In some embodiments, the first image may be alow dose level guiding image. In some embodiments, the acquisition unit410 may obtain the first image from a storage device in the radiationtherapy system 100, such as the storage device 150.

In some embodiments, the first scan may be a CBCT scan with the firstdose level performed by a CBCT scanner and/or an imaging component ofthe image-guided treatment apparatus 110. For example, the imagingcomponent of the image-guided treatment apparatus 110 may be a CBCTimaging component as described in connection with FIG. 1. Theimaging-radiation source 115 may perform scanning by emitting one ormore cone beam X-rays. The radiation dose level of the core beam X-raysmay be equal to the first dose level. Additionally or alternatively, thefirst scan may be performed by a CBCT scanner in the radiation therapysystem 100 (not shown in FIG. 1).

The first dose level may be any suitable value for a CBCT scan. In someembodiments, the first dose level may be selected based on the positionof the ROI (e.g., a tumor, an organ at risk). The first dose level fordifferent ROIs at different positions may be different from each other.Merely by way of example, the first dose level for an ROI in the headmay range from 0.5 mGy to 6 mGy. In some embodiments, the first scan maybe an MSCT scan with the first dose level performed by an MSCT scannerand/or an imaging component of the image-guided treatment apparatus 110.

The first image may be generated based on image data acquired from thefirst scan. One or more components (e.g., the process device 140) mayprocess the image data to provide the first image. The first imageand/or the corresponding image data may be stored in a storage device(e.g., the storage device 150). For example, the processing device 140may process and/or reconstruct the first image based the image dataacquired from the first scan, and transmit it to the storage device 150.

To perform the first scan of a subject based on the planning image, oneor more tattoos and/or makers may be marked on the skin of the subjectby, for example, a doctor, an imaging specialist, etc., to identify atarget treatment area before treatment. In the first scan, the subjectmay be placed, based on the one or more tattoos and/or markers, at thesame (or essentially the same) position as that when the planning imagewas taken.

In 506, the first image may be registered with the planning image togenerate a registered first image. In some embodiments, 506 may beperformed by the registration unit 420. The registration may beperformed based on any suitable image registration techniques including,for example, a voxel-based registration technique, a landmark-basedregistration technique, a segmentation-based registration technique, orthe like, or a combination thereof. In some embodiments, theregistration may be a rigid registration. In some embodiments, theregistration may be a non-rigid deformable registration.

Merely by way of example, the first image may be registered with theplanning image based the landmark-based registration technique. Thelandmark for registration may be a visible anatomical point that can beidentified and located. For example, the landmark may be a bone. In theregistration, the registration unit 420 may align a landmark in theplanning image with a corresponding landmark in the first image. Theregistration of the first image with the planning image may be performedto remove at least part of an error due to, for example, themisalignment of the subject when the first image is acquired compared towhen the planning image was acquired. The misalignment may be caused by,for example, a weight change of the subject, an error in the setup ofthe subject for the acquisition of the first image, or the like, or acombination thereof.

In 508, the planning image may be compared with the registered firstimage to generate a first comparison result. In some embodiments, 508may be performed by the comparison unit 440. In some embodiments, theplanning image may be compared with the first image to generate a firstcomparison result. To compare the planning image with the registeredfirst image (or the first image), the anatomy information in theplanning image and the registered first image (or the first image) maybe compared. For example, the comparison unit 440 may determine a firstvalue of a metric based on the planning image and a second value of themetric based on the registered first image (or the first image). Thecomparison unit 440 may then compare the first value with the secondvalue by way of, e.g., determining a difference between the first valueand the second value. The difference between the first value and thesecond value of the metric may be designated as the first comparisonresult by the comparison unit 440.

The metric may include any suitable metric relating to a parameter orcharacteristic of an anatomical feature in the planning image and/or theregistered first image (or the first image). The anatomical feature inthe planning image and/or the registered first image (or the firstimage) may include a malignant tissue (e.g., a tumor, or a cancer-riddenorgan, or a non-cancerous target of radiation therapy) or other tissue(e.g., a tissue surrounding the malignant tissue) as described inconnection with 502. The metric may include the location of theanatomical feature, the shape of the anatomical feature, the density ofthe anatomical feature, the volume of the anatomical feature, anattenuation value of the anatomical feature, or the like, or anycombination thereof. Additionally or alternatively, the metric mayinclude any other suitable metric relating to the planning image and/orthe registered first image (or the first image), such as a volume of theimage. For instance, a sum of a whole image of a subject, including air,may be determined to provide the volume of the imaged anatomy, which mayserve as an indicator of the weight change of the subject. For anotherexample, volume of voxels containing fat may be determined to serve asan indicator of the weight change of the subject.

In 510, a determination may be made as to whether the first comparisonresult satisfies a first replanning condition. In some embodiments, 510may be performed by the comparison unit 440. The first replanningcondition may be a default condition retrieved from a storage device(e.g., the storage device 150) in the radiation therapy system 100 or beset by a user via the one or more terminals 130. In response to thedetermination that the first replanning condition is satisfied, 512 maybe performed. Otherwise, 518 may be performed.

As described in connection with 508, the first comparison result of theplanning image and the registered first image (or the first image) mayinclude a difference with respect to a metric between a first valueassociated with the planning image and a second value associated withthe registered first image (or the first image). The first replanningcondition may include a replanning threshold. According to the firstreplanning condition, when the difference exceeds the replanningthreshold, a deviation in the anatomical feature of the subject from theplanning image is determined to have exceeded a tolerable range andthus, a replanning is recommended. The replanning threshold may be adefault value retrieved from a storage device (e.g., the storage device150) or be set by a user via the one or more terminals 130. Additionallyor alternatively, the replanning threshold may be determined by acomponent of the radiation therapy system 100, such as the comparisonunit 440.

For illustration purposes, the present disclosure takes a density of themalignant tissue as an example. In some embodiments, the replanningthreshold of the density of the malignant tissue may be 0.01 g/cm³. Thecorresponding first replanning condition may be that the differencebetween a first density of the malignant tissue in the planning imageand a second density of the malignant tissue exceeds 0.01 g/cm³. In someembodiments, the replanning threshold regarding the density of themalignant tissue may be 0.1% of the first density of the malignanttissue in the planning image. The corresponding replanning condition maybe that the difference between the first density of the malignant tissueand the second density of the malignant tissue exceeds 0.1% of the firstdensity of the malignant tissue. It should be noted that the abovedescriptions are provided for the purposes of illustration, and notintended to limit the scope of the present disclosure. The replanningthreshold corresponding to the density of a malignant tissue may be anysuitable value. The first replanning condition may be based on a metricother than the density of the malignant tissue. In some embodiments,dual energy CT may be used to detect small changes in the attenuatingcharacteristics of the anatomy.

In some embodiments, in 508, a plurality of metrics of the planningimage and the registered first image (or the first image) may becompared. The first comparison result may include a difference betweenfirst value and second value for each metric. The first replanningcondition may include a plurality of sub-replanning conditionscorresponding to the plurality of metrics. The first replanningcondition may be satisfied when at least part of the sub-replanningconditions is satisfied.

In 512, a second image of the ROI relating to a second scan of the ROImay be obtained. In some embodiments, 512 may be performed by theacquisition unit 410. The second scan may be performed with a seconddose level. In some embodiments, the second scan may be an MSCT scanwith the second dose level performed by an MSCT scanner and/or an MSCTimaging component of the image-guided treatment apparatus 110. Thesecond image may be generated based on image data acquired from thesecond scan. The second scan may be reconstructed based on combined dataobtained during the first and second scan, in the case where the firstand second images are obtained using the same imaging and patientconfiguration. One or more components (e.g., the processing device 140)may process the image data to provide the second image. The second imageand/or the corresponding image data may be stored in a storage device(e.g., the storage device 150). Operations 512 and 504 may be performedin a substantially similar manner.

The second dose level may be any suitable value for an MSCT scan equalto or greater than the first dose level. In some embodiments, the seconddose level may be selected based on the position of the ROI (e.g., atumor, an organ at risk). The second dose level for different ROIs atdifferent positions may be different from each other. Merely by way ofexample, the second dose level for an ROI in the head may range from 8.7mGy to 40.0 mGy.

In 514, a second treatment plan may be generated based on the secondimage. In some embodiments, 514 may be performed by the treatment planunit 430. Additionally or alternatively, at least part of the secondtreatment plan may be generated based on an instruction of a user (e.g.,a doctor, a clinician). Merely by way of example, a clinician may inputa desired value or range of a radiation treatment parameter (e.g., aradiation dose level) based on the second image via the one or moreterminals 130. The second treatment plan may be generated by theradiation therapy system 100 according to or taking into considerationof the clinician's input.

The second treatment plan may include one or more treatment fractions.In some embodiments, the second treatment plan may include the samenumber of treatment fractions as the first treatment plan. In someembodiments, the second treatment plan may include more or fewertreatment fractions than the first treatment plan. For a treatmentfraction, the second treatment plan may include a plurality of secondtreatment parameters, such as a second planned fraction duration, asecond planned radiation dose level, a second planned radiation energydelivery direction, a second planned radiation energy beam shape, asecond planned radiation beam cross-sectional area.

In 516, an instruction may be sent to the image-guided treatmentapparatus 110 to deliver a treatment according to the second treatmentplan to the ROI. In some embodiments, 516 may be performed by thetreatment plan unit 430. The instruction may include the plurality ofsecond treatment parameters for each treatment fraction in the secondtreatment plan. The image-guided treatment apparatus 110 may deliver thesecond treatment plan based on the plurality of second treatmentparameters for each treatment fraction. In some embodiments, theinstruction may be a real-time instruction according to which atreatment is delivered upon or shortly after (e.g., within minutes,within hours, one the same day, etc.) the instruction is generated. Thereal-time instruction may cause the image-guided treatment apparatus 110to immediately or substantially immediately process the instruction anddeliver a treatment to the subject. In some embodiments, an instructionmay be non-real time for future treatment that is to be delivered, e.g.,on the second day, in a few days, etc. The non-real-time instruction mayrequire the image-guided treatment apparatus 110 to process theinstruction and deliver a treatment to the subject at a defined time. Insome embodiments, an instruction may include a real-time portion and anon-real time portion. For instance, the real-time portion is forimmediate or substantially immediate processing and delivery of atreatment fraction to the subject, while the non-real time portion isfor the delivery of one or more treatment fractions at one or moredefined times in the future.

In 518, in response to the determination that the first replanningcondition is not satisfied, an instruction may be sent to theimage-guided treatment apparatus 110 to deliver the first treatment planto the ROI. In some embodiments, 518 may be performed by the treatmentplan unit 430. Operations 518 and 516 may be performed in asubstantially similar manner.

In some embodiments, process 500 may terminate at 518 and does notproceed to node A 519 and perform at least some of operations startingfrom node A 519 illustrated in FIG. 5-B. In some embodiments, process500 may proceed further to 519 and perform at least some of operationsstarting from node A 519 illustrated in FIG. 5-B. In some embodiments,node A 519 may be performed after 510 is performed. Operation 518 andnode A 519 may be performed simultaneously. In some embodiments, in 508,the planning image may be compared with the first image directly togenerate a first comparison result, thus operation 506 may be omitted.

In 520, a second comparison result corresponding to a second treatmentfraction performed prior to the first treatment fraction may beobtained. In some embodiments, 520 may be performed by the acquisitionunit 410. The second comparison result corresponding to the secondtreatment fraction may be generated in a manner that is the same as orsimilar to the first comparison result, and stored in a storage devicein the radiation therapy system 100. For example, in the secondtreatment fraction, operations that are the same as or similar tooperations 504 to 508 may be performed to generate the second comparisonresult.

In 522, a determination may be made as to whether a second replanningcondition is satisfied based on the first comparison result and thesecond comparison result. In some embodiments, 522 may be performed bythe comparison unit 440. The determination may be made based on thefirst comparison result, the second comparison result, and the firstreplanning condition to assess a trend in which the comparison resultschange during the course of the treatment performed according to thetreatment plan(s). The trend, in turn, may serve as an indicatorregarding a change of the anatomical feature of a subject. In responseto the determination that the second replanning condition is satisfied,524 may be performed. Otherwise, 528 may be performed.

In some embodiments, a first difference corresponding to the firsttreatment fraction and a second difference corresponding to the secondtreatment fraction may be determined. The first difference may be adifference between the first comparison result and the replanningthreshold of the first replanning condition. The second difference maybe a difference between the second comparison result and the replanningthreshold of the first replanning condition.

For illustration purposes, the determination of the first difference isdescribed as an example. As described in connection with 508 and 510,the first comparison result may include a difference with respect to ametric between a first value associated with a planning image and asecond value associated with a registered first image (or a first image)acquired by a first scan. The first replanning condition may include areplanning threshold relating to the difference between the first valueand the second value of the metric. The first difference may be adifference between the replanning threshold and the first comparisonresult.

As described elsewhere in the present disclosure, the first differencecorresponding to the first treatment fraction and the second differencecorresponding to the second treatment fraction may indicate a trend inwhich comparison results change over the course of the treatment of thesubject according to the treatment plan(s). For example, when the firstdifference is less than the second difference, it may indicate a trendtoward the satisfaction of the first replanning condition.

In some embodiments, the second replanning condition may be that thefirst difference corresponding to the first treatment fraction is lessthan the second difference corresponding to the second treatmentfraction. Additionally or alternatively, the second replanning conditionmay be that the first difference is less than the second difference, andthe difference between the first difference and the second difference isgreater than a threshold. The satisfaction of the second replanningcondition may indicate that a replanning is needed.

In 524, a third image of the ROI relating to a third scan of the ROI maybe obtained. In some embodiments, 524 may be performed by theacquisition unit 410. The third scan may be performed with a third doselevel. In some embodiments, the third scan may be an MSCT scan with thethird dose level performed by an MSCT scanner and/or an MSCT imagingcomponent of the image-guided treatment apparatus 110. The third doselevel may be any suitable value for the MSCT scan greater than the firstdose level. In some embodiments, the third dose level may be associatedwith a position of the ROI (e.g., a tumor, an organ at risk). The thirddose level for different ROIs at different positions may be differentfrom each other. Merely by way of example, the third dose level for anROI in the head may range from 8.7 mGy to 22.0 mGy. Operations 524 and512 may be performed in a substantially similar manner.

In 526, a third treatment plan may be generated. In some embodiments,526 may be performed by the treatment plan unit 430. The generation ofthe third treatment plan may be performed based on the third image,and/or an instruction of a user (e.g., a doctor, a clinician).Operations 526 and 514 may be performed in a substantially similarmanner. In some embodiments, the third treatment plan may be generatedduring the course of radiation delivery according to the first treatmentplan (e.g., operation 518). For example, after 510 is performed,operation 518 and node A 519 may be performed simultaneously.

In 528, in response to the determination that the second replanningcondition is not satisfied, the process 500 may be ended.

It should be noted that the above descriptions of process 500 areprovided for the purposes of illustration, and not intended to limit thescope of the present disclosure. For persons having ordinary skills inthe art, various modifications and changes in the forms and details ofthe application of the above method and system may occur withoutdeparting from the principles of the present disclosure. However, thosevariations and modifications also fall within the scope of the presentdisclosure.

In some embodiments, one or more operations may be added or omitted. Forexample, some or all operations of 519 to 528 may be omitted. As anotherexample, operations 524 and 526 may be omitted. In response to thedetermination that the second replanning condition is satisfied,operations 512 and 514 may be performed to generate the second treatmentplan. In some embodiments, in 520, the acquisition unit 410 may obtain aplurality of previous comparison results corresponding to a plurality ofprior treatment fractions performed prior the first treatment fraction.The comparison unit 440 may determine whether a second replanningcondition is satisfied based on the first comparison result, theplurality of the previous comparison results, and the first replanningcondition. The second replanning condition may be satisfied when theprevious comparison results and the first comparison result indicate atrend toward satisfaction of the first replanning condition.

In some embodiments, additional operations may be performed after 518,or between 510 and 518, or between 508 and 510, to determine adifference between the first comparison result and the replanningthreshold of the first replanning condition as described in connectionwith 522. The comparison unit 440 may determine whether the differencesatisfies a third replanning condition, e.g., the difference being lessthan a threshold. In response to the determination that the thirdreplanning condition is satisfied, a fourth treatment plan may begenerated based on a fourth image of the ROI. The fourth treatment planmay be generated before or during the course of radiation deliveryaccording to the first treatment plan (e.g., operation 518). The fourthimage may relate to an MSCT scan with a fourth dose level. The fourthdose level may be equal to or greater a the first dose level. The fourthtreatment plan may be generated in a manner substantially similar to thegenerations of the second treatment plan, and/or the third treatmentplan as described in connection with FIGS. 5-A and 5-B.

The various dose levels of the scans described above may be selectedindependently based on considerations including, for example, theposition to be scanned and/or the type of scan to be performed (e.g.,relevant description in connection with 510 in FIG. 5-A, 522 in FIG.5-B, etc.). At least two of the first dose level of the first scan, thesecond dose level of the second scan, the third dose level of the thirdscan, the fourth dose level of the fourth scan, etc., describedelsewhere in the present disclosure may be different. For instance, thefirst dose level may be different from the second dose level or thethird dose level, or the fourth dose level. At least two of the firstdose of the first scan, the second dose of the second scan, the thirddose of the third scan, the fourth dose of the fourth scan, etc.,described elsewhere in the present disclosure may be the same. Forinstance, the second dose may be the same as the third dose or thefourth dose.

In some embodiments, process 500 may be performed before the delivery ofa treatment fraction. In some embodiments, process 500 is performedperiodically before each treatment fraction, or every other treatmentfraction, etc. In some embodiments, process 500 is performednon-periodically according to a decision made by, e.g., a doctor, theradiation therapy system 100, etc. Such a decision may be made based onan observation regarding the subject (e.g., an abrupt weight loss/gain),a testing result (e.g., the result of a blood test), informationprovided by the subject (e.g., a description regarding his/her owncondition), or the like, or a combination thereof.

Having thus described the basic concepts, it may be rather apparent tothose skilled in the art after reading this detailed disclosure that theforegoing detailed disclosure is intended to be presented by way ofexample only and is not limiting. Various alterations, improvements, andmodifications may occur and are intended to those skilled in the art,though not expressly stated herein. These alterations, improvements, andmodifications are intended to be suggested by this disclosure, and arewithin the spirit and scope of the exemplary embodiments of thisdisclosure.

Moreover, certain terminology has been used to describe embodiments ofthe present disclosure. For example, the terms “one embodiment,” “anembodiment,” and/or “some embodiments” mean that particular feature,structure or characteristic described in connection with the embodimentis included in at least one embodiment of the present disclosure.Therefore, it is emphasized and should be appreciated that two or morereferences to “an embodiment” or “one embodiment” or “an alternativeembodiment” in various portions of this specification are notnecessarily all referring to the same embodiment. Furthermore, theparticular features, structures or characteristics may be combined assuitable in one or more embodiments of the present disclosure.

Further, it will be appreciated by one skilled in the art, aspects ofthe present disclosure may be illustrated and described herein in any ofa number of patentable classes or context including any new and usefulprocess, machine, manufacture, or composition of matter, or any new anduseful improvement thereof. Accordingly, aspects of the presentdisclosure may be implemented entirely hardware, entirely software(including firmware, resident software, micro-code, etc.) or combiningsoftware and hardware implementation that may all generally be referredto herein as a “unit,” “module,” or “system.” Furthermore, aspects ofthe present disclosure may take the form of a computer program productembodied in one or more computer readable media having computer readableprogram code embodied thereon.

A computer readable signal medium may include a propagated data signalwith computer readable program code embodied therein, for example, inbaseband or as part of a carrier wave. Such a propagated signal may takeany of a variety of forms, including electro-magnetic, optical, or thelike, or any suitable combination thereof. A computer readable signalmedium may be any computer readable medium that is not a computerreadable storage medium and that may communicate, propagate, ortransport a program for use by or in connection with an instructionexecution system, apparatus, or device. Program code embodied on acomputer readable signal medium may be transmitted using any appropriatemedium, including wireless, wireline, optical fiber cable, RF, or thelike, or any suitable combination of the foregoing.

Computer program code for carrying out operations for aspects of thepresent disclosure may be written in any combination of one or moreprogramming languages, including an object oriented programming languagesuch as Java, Scala, Smalltalk, Eiffel, JADE, Emerald, C++, C #, VB.NET, Python or the like, conventional procedural programming languages,such as the “C” programming language, Visual Basic, Fortran 2103, Perl,COBOL 2102, PHP, ABAP, dynamic programming languages such as Python,Ruby and Groovy, or other programming languages. The program code mayexecute entirely on the user's computer, partly on the user's computer,as a stand-alone software package, partly on the user's computer andpartly on a remote computer or entirely on the remote computer orserver. In the latter scenario, the remote computer may be connected tothe user's computer through any type of network, including a local areanetwork (LAN) or a wide area network (WAN), or the connection may bemade to an external computer (for example, through the Internet using anInternet Service Provider) or in a cloud computing environment oroffered as a service such as a Software as a Service (SaaS).

Furthermore, the recited order of processing elements or sequences, orthe use of numbers, letters, or other designations therefore, is notintended to limit the claimed processes and methods to any order exceptas may be specified in the claims. Although the above disclosurediscusses through various examples what is currently considered to be avariety of useful embodiments of the disclosure, it is to be understoodthat such detail is solely for that purpose, and that the appendedclaims are not limited to the disclosed embodiments, but, on thecontrary, are intended to cover modifications and equivalentarrangements that are within the spirit and scope of the disclosedembodiments. For example, although the implementation of variouscomponents described above may be embodied in a hardware device, it mayalso be implemented as a software only solution, for example, aninstallation on an existing server or mobile device.

Similarly, it should be appreciated that in the foregoing description ofembodiments of the present disclosure, various features are sometimesgrouped together in a single embodiment, figure, or description thereoffor the purpose of streamlining the disclosure aiding in theunderstanding of one or more of the various inventive embodiments. Thismethod of disclosure, however, is not to be interpreted as reflecting anintention that the claimed subject matter requires more features thanare expressly recited in each claim. Rather, inventive embodiments liein less than all features of a single foregoing disclosed embodiment.

In some embodiments, the numbers expressing quantities or propertiesused to describe and claim certain embodiments of the application are tobe understood as being modified in some instances by the term “about,”“approximate,” or “substantially.” For example, “about,” “approximate,”or “substantially” may indicate ±20% variation of the value itdescribes, unless otherwise stated. Accordingly, in some embodiments,the numerical parameters set forth in the written description andattached claims are approximations that may vary depending upon thedesired properties sought to be obtained by a particular embodiment. Insome embodiments, the numerical parameters should be construed in lightof the number of reported significant digits and by applying ordinaryrounding techniques. Not withstanding that the numerical ranges andparameters setting forth the broad scope of some embodiments of theapplication are approximations, the numerical values set forth in thespecific examples are reported as precisely as practicable.

Each of the patents, patent applications, publications of patentapplications, and other material, such as articles, books,specifications, publications, documents, things, and/or the like,referenced herein is hereby incorporated herein by this reference in itsentirety for all purposes, excepting any prosecution file historyassociated with same, any of same that is inconsistent with or inconflict with the present document, or any of same that may have alimiting affect as to the broadest scope of the claims now or laterassociated with the present document. By way of example, should there beany inconsistency or conflict between the description, definition,and/or the use of a term associated with any of the incorporatedmaterial and that associated with the present document, the description,definition, and/or the use of the term in the present document shallprevail.

In closing, it is to be understood that the embodiments of theapplication disclosed herein are illustrative of the principles of theembodiments of the application. Other modifications that may be employedmay be within the scope of the application. Thus, by way of example, butnot of limitation, alternative configurations of the embodiments of theapplication may be utilized in accordance with the teachings herein.Accordingly, embodiments of the present application are not limited tothat precisely as shown and described.

I claim:
 1. A system, comprising: one or more scanners; at least onenon-transitory storage medium including a set of instructions foradapting treatment plan; and at least one processor configured tocommunicate with the at least one non-transitory storage medium, whereinwhen executing the set of instructions, the system is directed to:obtain a planning image of a region of interest relating to a firsttreatment plan; obtain a first image of the region of interest relatingto a first scan of the region of interest with a first dose leveldelivered by the one or more scanners; compare the planning image withthe first image to generate a first comparison result; determine whetherthe first comparison result satisfies a first replanning condition;cause, in response to a determination that the first comparison resultsatisfies the first replanning condition, the one or more scanners toperform a second scan with a second dose level to provide a secondimage; and generate a second treatment plan according to the secondimage, wherein the second dose level is higher than the first doselevel.
 2. The system of claim 1, wherein the system is further directedto: send an instruction to a radiation treatment device to deliver thesecond treatment plan to the region of interest.
 3. The system of claim1, wherein the first scan is a cone beam computed tomography (CBCT)scan, and the second scan is a multislice computed tomography (MSCT)scan.
 4. The system of claim 1, wherein to compare the planning imagewith the first image, the system is further directed to: determine atleast one first value with respect to at least one metric based on theplanning image; determine at least one second value with respect to theat least one metric based on the first image; and compare the at leastone first value with the at least one second value.
 5. The system ofclaim 4, wherein to determine whether the first comparison resultsatisfies the first replanning condition, the system is further directedto: determine whether a difference between the first value and thesecond value exceeds a threshold.
 6. The system of claim 4, wherein theat least one metric is associated with an anatomical feature in theregion of interest.
 7. The system of claim 1, wherein the system isfurther directed to: send, in response to a determination that the firstcomparison result fails to satisfy the first replanning condition, aninstruction to the radiation treatment device to deliver the firsttreatment plan to the region of interest.
 8. The system of claim 7,wherein the system is further directed to: obtain at least one secondcomparison result of at least one second treatment fraction performedprior to the first treatment fraction; based on the first comparisonresult and the at least one second comparison result, determine whethera second replanning condition is satisfied; obtain, in response to thedetermination that the second replanning condition is satisfied, a thirdimage relating to a third scan of the region of interest; determine athird treatment plan based on the third image, wherein the third scan isan MSCT scan with a third dose level delivered by MSCT; wherein thethird dose level is greater than the first dose level.
 9. The system ofclaim 7, wherein the treatment plan includes a plurality of treatmentfractions, the system is further directed to: determine whether thefirst comparison result satisfies a third replanning condition; obtain,in response to the determination that the first comparison resultsatisfies the third replanning condition, a fourth image relating to afourth scan of the region of interest; and determine a fourth treatmentplan based on the fourth image, wherein the fourth scan is an MSCT scanwith a fourth dose level delivered by MSCT; wherein the fourth doselevel is greater than the first dose level.
 10. The system of claim 1,wherein the first and second scan are multislice computed tomography(MSCT) scans.
 11. The system of claim 1, wherein the first image or thesecond image is an MSCT image obtained by a MSCT scanner, and MSCTimaging bore of the MSCT scanner shares a common axis of rotation with abore of a radiation treatment device.
 12. A computer-implemented methodfor adapting a treatment plan, the method comprising the followingoperations performed by at least one processor: obtaining a planningimage of a region of interest relating to a first treatment fraction ofa first treatment plan; obtaining a first image of the region ofinterest relating to a first scan of the region of interest with a firstdose level delivered by the one or more scanners; comparing the planningimage with the first image to generate a first comparison result;determining whether the first comparison result satisfies a firstreplanning condition; causing, in response to a determination that thefirst comparison result satisfies the first replanning condition, one ormore scanners to perform a second scan with a second dose level toprovide a second image; and generating a second treatment plan accordingto the second image, wherein the second dose level is higher than thefirst dose level.
 13. The method of claim 12, further comprising:sending an instruction to a radiation treatment device to deliver thesecond treatment plan to the region of interest.
 14. The method of claim12, wherein the first scan is a cone beam computed tomography (CBCT)scan, and the second scan is a multislice computed tomography (MSCT)scan.
 15. The method of claim 12, wherein comparing the planning imagewith the first image, the at least one processor further comprising:determining at least one first value with respect to at least one metricbased on the planning image; determining at least one second value withrespect to the at least one metric based on the first image; andcomparing the at least one first value with the at least one secondvalue.
 16. The method of claim 15, wherein determining whether the firstcomparison result satisfies the first replanning condition furthercomprising: determining whether a difference between the first value andthe second value exceeds a threshold.
 17. The method of claim 15,wherein the at least one metric is associated with an anatomy feature inthe region of interest.
 18. The method of claim 12, further comprising:sending, in response to the determination that the first comparisonresult fails to satisfy the first replanning condition, an instructionto the radiation treatment device to deliver the first treatment plan tothe region of interest.
 19. The method of claim 18, further comprising:obtaining at least one second comparison result of at least one secondtreatment fraction performed prior to the first treatment fraction;based on the first comparison result and the at least one secondcomparison result, determining whether a second replanning condition issatisfied; obtaining, in response to the determination that the secondreplanning condition is satisfied, a third image relating to a thirdscan of the region of interest; determining a third treatment plan basedon the third image, wherein the third scan is an MSCT scan with a thirddose level delivered by MSCT; wherein the third dose level is greaterthan the first dose level.
 20. The method of claim 18, furthercomprising: determining whether the first comparison result satisfies athird replanning condition; obtaining, in response to the determinationthat the first comparison result satisfies the third replanningcondition, a fourth image relating to a fourth scan of the region ofinterest; and determining a fourth treatment plan based on the fourthimage, wherein the fourth scan is an MSCT scan with a fourth dose leveldelivered by MSCT; wherein the fourth dose level is greater than thefirst dose level.
 21. The method of claim 12, wherein the first scan andthe second scan are multislice computed tomography (MSCT) scans.
 22. Themethod of claim 12, wherein the first image or the second image is anMSCT image obtained by a MSCT scanner, and MSCT imaging bore of the MSCTscanner shares a common axis of rotation with a bore of a radiationtreatment device.
 23. A non-transitory computer-readable storage mediumincluding instructions that, when accessed by at least one processor ofa system, causes the system to perform a method including: obtain aplanning image of a region of interest relating to a first treatmentfraction of a first treatment plan; obtain a first image of the regionof interest relating to a first scan of the region of interest with afirst dose level delivered by the one or more scanners; compare theplanning image with the first image to generate a first comparisonresult; determine whether the first comparison result satisfies a firstreplanning condition; cause, in response to a determination that thefirst comparison result satisfies the first replanning condition, one ormore scanners to perform a second scan with a second dose level toprovide a second image; and generate a second treatment plan accordingto the second image, wherein the second dose level is higher than thefirst dose level.